Efforts to target and assess the nutritional
effects of food and nutrition programmes suffer from the lack of
a unique or commonly agreed-upon indicator of nutrition impact.
Anthropometric measures such as weight- and height-for-age are
frequently used in evaluations of nutrition or food distribution
programmes, while the impact on the food acquisition of
calorie-deficient households is more often used as a proxy for
the nutritional effects of food and agricultural policies and
programmes. The impact on the food consumption of malnourished
individuals is used in some cases, but much less frequently
because it is more difficult and costly to obtain reliable data
on an individual's food consumption than to obtain his or her
anthropometric measurements, or data on household food
acquisition.

Attempts to establish a direct causal link
between individual anthropometric measures and the effects of
nutrition programmes have been disappointing because the
intermediate steps and relationships influencing or determining
the nutrition effects often are ignored. Results of the
evaluations of many nutrition programmes have thus been
inconclusive. It is quite possible that in many cases the actual
impact on nutrition went undetected but could have been detected
if the most important intermediate relationships, such as the
impact of the programme on household and/or individual food
consumption, had been taken into account. Changes in household
food acquisition? similarly, may be a poor proxy for the impact
on an individual member's nutritional status. This is because the
intra-household food distribution patterns are ignored, as is the
impact of changes in an individual's food consumption on his or
her nutritional status.

This paper addresses the question of whether or
not collecting data on individual household members' food
consumption is likely to greatly enhance the reliability of
efforts to target food and nutrition programmes to households
with malnourished individuals, when malnutrition is measured in
terms of calorie intake relative to requirements. The paper
specifically seeks to answer three related questions:

How efficient are estimates of
household-level calorie adequacy as a proxy for the
calorie adequacy of pre-schoolers and pregnant or
lactating women? The answer to this question is crucial
to the effective targeting of programmes to households
with malnourished members. Can such targeting be based on
household-level food consumption data, or must food
consumption data be collected on individual high-risk
household members?

How efficient is weight-for-age as a proxy
for the calorie adequacy of preschoolers? This is of
particular importance in efforts to target programmes to
households including caloriedeficient pre-schoolers,
because weight data are far easier to collect than data
on individual pre-schoolers' calorie consumption.

Is the calorie adequacy of individual
pre-schoolers and pregnant or lactating women closely
correlated with other variables for which data are easier
to collect, such as household calorie consumption,
household income, and individual anthropometric measures?
A high correlation with one of these variables would
indicate that collection of data on individual food
consumption might not be essential.

Answers to these questions should assist in
assessing whether the increased cost of collecting data on
individual food consumption can be justified as part of efforts
to target nutrition programmes more effectively. This paper
should contribute to a better understanding of the trade-offs
between cost and reliability of the collection of household-
versus individual-level food-consumption data.

SAMPLE DESCRIPTION

The analysis presented here is based on data
collected as part of a consumer food-price subsidy scheme in
three regions of the Philippines' (Garcia and Pinstrup-Andersen,
1987). Data on household-level variables were collected twice
during 1983 from a cross-section of 840 households.
Anthropometric data on pre-school children were collected monthly
from the same households over a 12-month period. Data on the food
consumption of individual household members were also obtained
twice, but only from a subsample of 134 households (table 1).

The sample was selected from a population of
low-income households with a high probability of malnutrition.
The overall calorie adequacy for the sample was 70 per cent, as
compared to 89 per cent for the Philippines as a whole. About
one-third of the sample pre-schoolers had second- or third-degree
malnutrition, as compared to 17 per cent for the Philippines as a
whole (table 2). Estimated calorie adequacy was low among sample
individuals regardless of age, sex, and region. Calorie adequacy
was calculated as actual consumption relative to recommended
daily allowances. The latter are shown in the Appendix to this
chapter. Severe calorie deficiencies were found among
pre-schoolers, particularly girls. Other population groups,
including adolescent girls and pregnant or lactating women, were
also seriously affected (table 3). This table indicates unequal
food distribution within the household. Two independent studies,
one in rural Laguna (Valenzuela, 1977), and the other in urban
Manila (Aligaen and Florencio, 1980), also reveal inequality in
food adequacy between adults and children.

Table 1. Sample size by region

Total sample households

Households in subsample

with
individual consumption

Region

Round 1a

Round 2

Round 1

Round 2

Abra

240

228

40

38

Antique

360

352

60

60

South
Cotabato

240

220

40

36

Total

840

800

140

134

a. The first survey round took place during
May-June 1983 and the second during September-October 1983.

Table 2. Percentage of sample pre-schoolers
falling into second- and third-degree malnutrition on the basis
of weight-for-age

Region

Percentage
second and third degree

Abra

25.5

Antique

34 4

South
Cotabato

37.2

Total sample

32.5

Philippines
(FNRI, 1982)

17.2

Sources: IFPRI/National Nutrition Council
Survey,1983; Food and Nutrition Research Institute, Second
Nationwide Nutrition Survey of the Philippines (NSTA, Manila,
1982).

Table 3. Estimated calorie adequacy (in
percentage of RDA) of various sex- and age-groups of sample by
regiona

Population
group

Abra

Antique

South
Cotabato

Fathers

75.5

83.9

86.8

Pregnant
women

70.1

63.3

46.4

Lactating
women

67.1

71.1

62.9

Adults

Male

75.8

81.3

83.7

Female

77.6

81.9

71.5

Adolescents

Male

62.2

65.0

57.2

Female

53.6

64.9

50.4

Schoolers

Male

56.4

72.4

66.3

Female

56.8

66.6

62.7

Pre-schoolers

Male

57.2

69.7

63.7

Female

49.5

62.3

61.8

Average,
household

65.7

73.6

70.1

Overall
average

70.4

The
Philippines (FNRI)

88.6

a. See Appendix to chapter for RDA for calories
for Filipinos Sources IFPRI/National Nutrition Council
Survey,1983; Food and Nutrition Research Institute Second
Nationwide Nutrition Survey of the Philippines (NSTA, Manila,
1982).

HOUSEHOLD ADEQUACY AS A PROXY FOR
ADEQUACY AMONG HIGH-RISK INDIVIDUALS

The efficiency of estimates of household-level
calorie adequacy as a proxy for the calorie adequacy of high-risk
household members, as shown in tables 4 and 5, will be discussed
in an attempt to answer question 1 above. Reliance on household
calorie adequacy as an indicator of the degree of calorie
adequacy of pre-schoolers introduces large errors. Only 39 per
cent of the households with pre-schoolers consuming less than
one-half of their calorie requirements would be captured by a
programme targeted on households below 50 per cent calorie
adequacy (24 per cent of all households). A programme targeted on
households consuming 60 per cent of requirements or less would
leave out 61 per cent of the pre-schoolers who consume 60 per
cent or less, including 29 per cent who consume less than 50 per
cent of their requirements (table 4).

Table 4. Relationship between calorie adequacy
of households and those of pre-schoolers within the households

Calorie adequacy of pre-schoolers (%)a

Household
calorie adequacy (%)b

0-50

51-60

61-80

81-100

Above 100

Total

0-50

Number
of households

43

17

42

7

2

111

Percentage
of sample

15.69

6.20

15.33

2.55

0.73

40.51

Row
percentage

38.74

15.32

37.84

6.31

1.80

Column
percentage

64.18

34.69

40.00

16.28

20.00

1-60

Number
of households

14

10

18

1

1

44

Percentage
of sample

5.11

3.65

6.57

0.36

0.36

16.06

Row
percentage

31.82

22.73

40.91

2.27

2.27

Column
percentage

20.89

20.41

17.14

2.33

10.00

61-80

Number
of households

8

17

31

16

1

73

Percentage
of sample

2.92

6.20

11.31

5.84

0.36

26.64

Row
percentage

10.96

23.28

42.46

21.92

1.37

Column
percentage

11.94

34.69

29.52

37.21

10.00

81-100

Number
of households

2

4

11

12

3

32

Percentage
of sample

0.73

1.46

4.02

4.38

1.09

11.68

Row
percentage

6.25

12.50

34.37

37.50

9.37

Column
percentage

2.98

8.16

10.48

27.91

30.00

Above
100

Number
of households

0

1

3

7

3

14

Percentage
of sample

0.00

0.36

1.09

2.55

1.09

5.11

Row
percentage

0.00

7.14

21.43

50.00

21.43

Column
percentage

0.00

2.05

2.86

16.28

30.00

Total

Number
of households

67

49

105

43

43

274

Percentage
of sample

24.45

17.88

38.32

15.69

3.65

100.00

a. Calorie consumption by household members
between 12 and 84 months of age divided by the sum of the RDAs
for these household members and multiplied by 100.
b. Total household calorie consumption divided by the sum of the
RDAs for all household members and multiplied by 100.

Source: IFPRI/National Nutrition Council Survey
in Abra, Antique, and South Cotabato, the Philippines. 1983.

Table 5. Relationship between calorie adequacy
of households and those of pregnant and lactating women within
the households

Calorie adequacy of pregnant and lactating women
(%)a

Household
calorie adequacy (%)b

0-50

51-60

61-80

81-100

Above 100

Total

0-50

Number of
households

17

2

2

1

0

22

Percentage of
sample

11.72

1.38

1.38

0.69

0.00

15.22

Row
percentage

77.30

9.10

9.10

4.50

0.00

Column
percentage

39.50

6.90

3.60

5 60

0.00

51-60

Number of
households

10

10

16

0

0

36

Percentage of
sample

6.90

6.90

11.03

0.00

0.00

24.80

Row
percentage

27.80

27.80

44.40

0.00

0.00

Column
percentage

23.30

34.50

29.10

0.00

0.00

61-80

Number of
households

12

14

23

4

0

53

Percentage of
sample

8.27

9.66

15.86

2.76

0.00

36.60

Row
percentage

22.60

26.40

43.40

7.50

0.00

Column
percentage

27.90

48.30

41.80

22.20

0.00

81-100

Number of
households

3

2

10

8

0

23

Percentage of
sample

2.07

1.38

6.90

5.52

0.00

15.80

Row
percentage

13.00

8.70

43.50

34.80

0.00

Column
percentage

7.00

6.90

18.20

44.40

0.00

Above
100

Number of
households

1

1

4

5

0

11

Percentage of
sample

0.69

0.69

2.76

3.45

0.00

7.60

Row
percentage

9.10

9.10

36.40

45.50

0.00

Column
percentage

2.30

3.40

7.30

27.80

0.00

Total

Number of
households

43

29

55

18

0

145

Percentage of
sample

29.60

20.00

37.90

12.40

0.00

100.00

a. Calorie consumption by pregnant and
lactating household members divided by their RDAs and multiplied
by 100.

b. Total household calorie consumption divided
by the sum of the RDAs for all household members and multiplied
by 100.

Source: IFPRI/National Nutrition Council Survey
in Abra, Antique, and South Cotabato, the Philippines, 1983.

Household-level calorie adequacy is a more
efficient indicator of the calorie adequacy level of pregnant and
lactating women (table 5). Thus, a programme targeting households
with atrisk women and calorie adequacy levels of 50 per cent or
less would capture 77 per cent of the pregnant and/or lactating
women whose calorie adequacy levels are 50 per cent or lower.

The problem of excluding such a large number of
target households through a targeting approach based on
household-level calorie adequacy is compounded by the inclusion
of a correspondingly large number of non-target households. Thus,
28 per cent of the households benefiting from a xprogramme
targeting households with preschoolers and with a household-level
calorie adequacy of 60 per cent or lower do not include any
pre-schoolers whose calorie adequacy is this low. Similarly, in
more than half of the households with pregnant and/or lactating
women which would be included on the basis of household-level
criteria, these women's calorie adequacy would be actually higher
than 60 per cent.